Supporting Loved Ones Through Eating Disorders
The Hard Truth
It is estimated that 1 in 5 women and 1 in 7 men will develop an eating disorder within their lifetime. Despite the high prevalence of eating disorders, many people feel completely lost and overwhelmed when supporting a loved one in recovery. The people supporting those fighting this disorder can get overlooked in how hard it is for them to navigate this journey alongside the person they care so deeply about.
I hear time and time again that loved ones express feeling blindsided by the disease. What once seemed like an innocent diet or healthy lifestyle change exposes itself to be a severe eating disorder stealing their loved one away from them.
As a therapist, I often wish I had a magic ball. I wish I could see into the future and reassure parents, partners, and friends that after a few months in treatment, their loved one would be cured. Unfortunately, recovering from an eating disorder is a complicated journey.
Here are some of the hard truths you should know:
Recovery is a marathon, not a sprint. Recovery takes an average of 7 to 10 years for someone to fully recover. Within this time frame, individuals may have long stretches of stable recovery, may need various degrees of professional support, and may cycle through various eating disorder behaviors and relapses. Recovery is not linear. In my own journey, I have been through numerous phases of growth and relapses. Recovery is also a lifelong journey. Be patient with your loved ones and know every up and down supports increasing knowledge, resilience, and the tools needed to find full freedom.
You can’t fight the eating disorder. That is one hard pill to swallow. However, working to understand and accept this reality is actually key in protecting your own mental health. Your loved one is responsible for their own recovery. They are the only person that has power in making lasting change. Loved ones can foster safety. You can create a safety net by preparing and monitoring meals, supporting access to professional support and resources, and by offering empathy when things get hard. However, I also encourage parents and partners to practice emotional detachment. Avoid getting into power struggles with the eating disorder, don’t take it personally when you are loved one is resisting recovery, and take time to invest in your own wellness. Learn to trust the safety net instead of focusing on your fears.
Your words matter. I can’t tell you how often I spend therapy sessions and group time helping individuals process through the hurtful things loved ones say. The biggest offenders are: comments on weight/ appearance (even if it seems complimentary), comments on food/ eating habits, threats or insults when someone is struggling, and comments that invalidate someone’s attempt at vulnerability. I once had a patient of mine say, “I don’t need my parents to understand, I just need them to believe me.” I understand your support will be imperfect. You will say the wrong thing- guaranteed. However, know empathy, validation, and unconditional positive regard are powerful tools in improving how you support your loved one. Here is a great video on offering empathy.
The eating disorder comes with a cost. Your loved one will miss out on opportunities and have to reconcile the impact of the eating disorder on their life. They may get behind in school, may struggle to maintain personal hygiene and cleanliness, may lose relationships, may have to drop out of their sport/ hobby, may struggle financially, may deal with lifelong health consequences, etc. It can be devastating for loved ones to witness the destructive nature of the eating disorder; however, it is not your job to protect your loved one from these disappointments. It is actually important for your loved one to confront the reality of the disease fully. Show up with empathy and hold space for the difficult emotions that your loved one will experience. Provide resources and tangible support when its recovery aligned. However, I caution loved ones against over empathizing with your loved one. Don’t let the fear of your loved one being disappointed prevent you from prioritizing the treatment they need. Examples of this are keeping them in a sport despite their active ED, choosing school over appointments, and disregarding treatment team recommendations. The hard decisions you make for your loved one’s recovery are often the most important. This tells your loved one recovery comes first. Their health is not something you are willing to negotiate.
The eating disorder is a trauma to the whole support system. It makes sense you feel overwhelmed as you support your loved one’s recovery. Again, the eating disorder often shows up in a blindside. It makes sense you feel hyper vigilant and on edge, nervous you will miss the eating disorder regaining control. Prioritize therapy for yourself. Find ways to process your anxiety and feelings. Practice healthy coping. Take time for respite and lean on your own support system. The eating disorder is manipulative, deceitful, and stubborn. Recovery is hard. As you go through this journey, don’t forget that your loved one is so much more than their eating disorder. Focus on the moments of joy, celebration, and growth. Remind yourself of their strengths and all the qualities that make them special. At the end of the day, the majority of people with eating disorders recover. Take it one day at a time and don’t lose hope.
With time, patience, and trust, recovery for your loved one is possible; but, it doesn’t happen overnight… and it doesn’t happen in your time… it happens in their own time
General Tips for support
Recognize that you are not to blame.
Acknowledge to your loved one that they are not to blame.
Recognize how distressing the illness is for your loved one.
Educate yourself about eating disorders where you can.
Ask your loved one how they are feeling and what they are thinking, rather than making assumptions.
Avoid discussing weight, shape, food, and diets in front of your loved one, and model a balanced relationship with your own food and exercise.
Remind yourself that things can change and reassure your loved one that recovery is possible.
Ask your loved one what you can do to help – for example, helping them to stick to regular eating, putting in boundaries following mealtimes, having a space to talk about how they are feeling. Your loved one may respond that you can just “leave them alone” or that you can’t do anything to help, so here it can be helpful to remind them you can hear their distress and how difficult things are, and you are there if they need you.
Recognize any ‘accommodating or enabling behaviors’ – behaviors that you do to help reduce your loved one’s distress from the eating disorder, for example, cleaning up vomit or cooking different meals for them, but that collude with the disorder and cover up the negative consequences of the behaviors.
Mealtimes:
Mealtimes can be really difficult for both those suffering with an eating disorder and those supporting them. But there are things that you can do to help things go more smoothly and feel more comfortable for your loved one.
Ensure you have everything you need for the planned meal to avoid last-minute changes that could increase anxiety.
If you are eating together, plan with your loved one what you will be eating, at what time, who else will be there, and think about portion sizes.
If your loved one is struggling to food shop due to anxiety about things such as nutritional labels, either offer to do the shopping for them or go together to help support them.
Some people who binge eat may have difficulty with the abundance of food in supermarkets; therefore writing a list and shopping together for this can be helpful. Food shopping via the internet can also be helpful for some people.
Often during treatment, avoided foods will need to be reintroduced. Planning the day and time that this will be along with the treatment team, and shopping for it together, can help this process feel more in your loved one’s control.
When shopping, multipacks of avoided or fear foods can seem overwhelming, particularly if it is a food that the person tends to restrict or binge on. Buying the food as a single item rather than part of a multipack could be more manageable for your loved one.
Ask your loved one what would be most helpful during the mealtime. Some examples of things that have helped other people are having the television or radio on, colouring tablecloths, doing a puzzle or being involved in conversation. Come up with a list of distraction techniques with them for them to use when they are struggling – this could be helpful outside mealtimes too.
Keep conversation neutral at mealtimes, so avoid discussing topics such as diets, exercise or how treatment is going.
In people with restrictive eating disorders, eating regularly again can bring about physical discomfort such as stomach pain and feeling full very quickly – it is important to follow the advice of your loved one’s treatment team in response to this. This may require supporting your loved one with pushing through this discomfort and continuing to eat regularly.
Evening times are often the most vulnerable time for people who binge eat – ask your loved one what you can do to help with this, or at other times that they may find difficult.
Socializing
People with eating disorders may become withdrawn, and you may need to go to more effort than usual to make them feel included and stop them from isolating themselves.
Even if their eating disorder causes them to withdraw, keep inviting them to join in with group and family activities.
Think of social events that don’t revolve around food or exercise, such as trying out different crafts, or playing board games.
Take time to discuss topics outside of the illness and treatment – this can feel very tricky but your loved one is still there despite the eating disorder.
Help your loved one try out new hobbies or return to hobbies that they used to enjoy. If your loved one enjoyed sports or exercise prior to developing the eating disorder and this became a problem, ensure that you consult with their medical professional about the best way to manage this.
Difficult situations
Eating disorders can make people behave in ways that seem out of character. While early treatment is always the best option and will give the sufferer the best chance of getting completely better, this can be upsetting and frightening, and they may try to resist it. Emotional or aggressive outbursts and hurtful comments or responses to your attempts to help aren’t uncommon, especially when the person feels challenged – remember this is not them but the eating disorder speaking. There are some things that you can keep in mind to make these times more manageable and avoid escalating the situation.
It might be best to walk away and talk once everyone involved has calmed down. Think about how best to ensure that you, your loved one and anyone else present are safe, and put into place the necessary actions.
Try to resist any urge to respond to anger by getting angry yourself. It’s reasonable to feel frustrated, but try to avoid expressing that in front of your loved one.
Try not to feel too guilty if you do find yourself getting angry at them. Make time when things have calmed down to explain your emotions to your loved one, and try to encourage them to do the same. Each of you clearly communicating your views and feelings might make it easier to avoid the situation in the future.
After the situation has calmed down, take time to look after your own needs. You can explain to your loved one that you love them and don’t blame them for how they reacted, but that you are going to take some time to go to another room to call a friend, or to go for a walk to look after your own wellbeing. Here you are letting them know that you love them, but also recognising the importance of self-compassion and modelling this to them.
When talking about the situation, show that you have heard your loved one’s concerns or difficulties by repeating some of the words they have used and reflecting these back to them. For instance, if they have shouted at you: “I would be fine if you backed off. You just make things worse,” you could reply with “What can I do so that I’m not making things worse?” This signals to your loved one that you have heard them and are listening. Remember that, much as the person you’re supporting is ill, there are still boundaries. They don’t have the right to hurt other people, even if they’re finding things difficult. When things are calm, be clear with them about what is and isn’t acceptable.
Talk to other people involved about how to handle situations where emotions are running high. It’s best to come up with a plan where you work together, as conflicting approaches to defusing a situation may make things worse. You will probably find it useful to discuss this with your loved one’s clinician as well.
Food Language
The eating disorder can cause your loved one to misinterpret what is being said to them, which can leave you unsure of what to say and concerned about upsetting them. Below are some examples of things that you may innocently say, and what the eating disorder may cause your loved one to hear instead. It could be helpful to share these with other people likely to talk to your loved one, to help them to understand more about the eating disorder and avoid upsetting conversations.
Just eat normally.
What may be heard: You’re not trying hard enough, it’s not difficult to eat, it’s your fault, you need to get over this.
Positive alternative: To outsiders it may seem like people with eating disorders just need to eat, or just need to stop purging or binge eating. This is not the case – eating disorders are not a choice but are severe mental illnesses that the person needs supporting through. It is therefore important to acknowledge to the person that you know it’s difficult for them, and you are there to support them.
You look well.
What may be heard: You look fat, you have gained weight, you’re greedy, you’re healthy now so things are easy for you.
Positive alternative: Any comments to do with your loved one looking “healthier” or “better” are often taken to mean they have put on weight. Instead of commenting on their physical appearance, try to ask the person how they are, or compliment something about your loved one that is unrelated to their body such as an item of clothing or an accessory.
I wish I had your control.
What may be heard: You are lucky to have an eating disorder, you are in control of the illness, it’s a good thing to be obsessive with food, weight and shape.
Positive alternative: Often eating disorders are used as a coping mechanism and a way to feel in control. However, when someone is suffering from an eating disorder the illness controls them and fighting against the thoughts and behaviours is extremely difficult. Avoid commenting on the eating disorder as if it is the person’s choice.
You just need to stop eating so much.
What may be heard: You are fat, you are greedy, binge eating isn’t a problem, you are making this up, it is easy to stop binge eating.
Positive alternative: Acknowledge how difficult things are for your loved one, and how distressing the eating disorder must be. Let them know that you are there to support them.
Get well soon.
What is heard: It’s easy to get over this, you aren’t trying hard enough, you are being a burden, hurry up and get better.
Positive alternative: Reassure your loved one that although you recognise how difficult things are for them, you are there for them and will continue to be throughout. Let them know how proud you are of them for challenging the illness.
I wish I had your body.
What is heard: You are lucky to have an eating disorder, you are just doing this to look a certain way, you need to keep doing the disordered behaviours.
Positive alternative: Try to avoid discussing your own weight and shape in front of your loved one as it can be unhelpful for them to hear. Instead focus on topics away from body image, food or exercise.
I can easily finish a packet of biscuits so know exactly how you feel.
What is heard: Everyone eats that way, you don’t have a problem, it is normal to binge eat, you don’t deserve support.
Positive alternative: While many people will overeat on occasion, and this may be triggered by difficult emotions, this is not the same as having binge eating disorder. Binge eating disorder is extremely distressing for the person and involves the person feeling a loss of control while eating a much larger amount of food than most people would eat in similar circumstances. It is good to be understanding, but important to avoid trivialising what the person is going through.
Externalizing the illness
Externalizing the eating disorder – viewing it as separate to your loved one – can empower you to help distance them from the illness and challenge the eating disorder behaviors. This challenge to the eating disorder may lead to your loved one acting out of character, but this is often the illness reacting as it feels threatened. By externalizing the illness, you can also help your loved one to recognise their thoughts and behaviors as resulting from the eating disorder. To do this, it can be useful to address the eating disorder as distinct from your loved one.
For example:
“What did the eating disorder say to make you feel unable to eat your snack?”
“What did the eating disorder say to trick you into purging after your dinner?”
“How does the eating disorder make you feel about yourself?”
Externalising the eating disorder can also help your loved one to feel less like they are being criticised or are to blame: you both recognise that it is the eating disorder.
Externalising the eating disorder will not be helpful for everyone. Some people may feel that the eating disorder is part of them, rather than separate, and may struggle with questions such as those above or find them patronising. It could also feel dismissive of what is going on for the person. If this is the case, it could be helpful to explore this with your loved one and their treatment team, to find a dialogue that works for everyone.
When your loved one in recovering
Validation and compassion are key! Validate their fears and struggles without judgment.
Be willing to adapt to changes in a recovery plan.
Have the ability to incorporate love and fun into the recovery process — recovery free time.
Focus on the person, not the eating disorder. They are not their eating disorder.
Remind your loved one that they are not alone.
You don’t need to fully understand the disease, but be there and be present.
Understand that the eating disorder did not happen overnight, nor will recovery. Progress, not perfection, is key.
There is no “perfect” recovery— people recover to life, not utopia.
Don’t tip-toe around your loved one— be real and honest but not pushy.
Slips and falls will happen— acknowledge them but don’t catastrophize them. Every time they pick themselves up they will get stronger.
Triggering people, places, and things will emerge—be there for support.
Ask your loved one what they need from you— be their ally on their journey to recovery.
YOU are an asset to your loved one’s recovery process. You are an expert when it comes to them; don’t be afraid to utilize those intuitions.
Take care of yourself so you can truly take care of your loved one— breathe, and keep going.
Things to Remember: Don't forget CPR!
C
You didn’t CAUSE it.
You can’t CONTROL it.
You can’t CURE it.
You can learn how NOT to CONTRIBUTE to it.
You need to learn how to COPE with it.
Take CARE of yourself.
P
Avoid PANIC. It prohibits clear thinking and calm reactions.
Recovery is a PROCESS. Two steps forward and one backwards.
PROGRESS, not PERFECTION, is the goal.
PATIENCE is critical.
R
RESPOND instead of REACT.
REMEMBER to listen.
REFLECT and REASON before you speak.
RECOVERY is a journey, a long ROAD that may include RELAPSE.
REACH out to others for love and support.
About the author
Madisen Schillo is a therapist here at Minnesota Attachment Collective. She is passionate about supporting folks heal from eating disorders and distorted body image due to her own life experiences. If you are in Minnesota and looking for a therapist, you can learn more about Maddie here as well as our therapy offerings here!
